Notes

Modern intensive care practice and developments in ventilator technology have rendered the use of muscle relaxants less common. Furthermore, it is rarely necessary to fully paralyse muscles to facilitate mechanical ventilation.

Requirement for muscle relaxants should be reassessed frequently. Ideally, relaxants should be stopped intermittently to allow depth of sedation to be assessed. If mechanical ventilation proceeds smoothly when relaxants have been stopped they probably should not be restarted.

Suxamethonium is contraindicated in spinal neurological disease, hepatic disease and for 5-50 days after burns.

Atracurium is non-cumulative and popular for infusion. Non-enzymatic (Hoffman) degradation allows clearance independent of renal or hepatic function, although effects are prolonged in hypothermia.